E-ISSN 2231-3206 | ISSN 2320-4672
 

Original Research 


Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar.

Cited by (2)

Abstract
Background: Diabetic autonomic neuropathy is a serious and common complication of diabetes mellitus and in fact it is one of the most overlooked complications, thus very limited clinical and research data are available on early renal and cardiovascular autonomic complications in type 2 diabetes mellitus.

Aims & Objective: To determine the possible association of elevated albumin excretion rate with cardiovascular autonomic activity in type 2 diabetes mellitus.

Materials and methods: A cross-sectional study was conducted with one hundred and fifteen patients of type 2 diabetes mellitus. Microalbuminuria was defined as Albumin Excretion Rate (AER) > 30 mg/24 hr in an early morning urine sample. Nine parameters reflecting different aspects of cardiovascular autonomic function were measured and were summarized in a single cardiovascular autonomic function score (CAFS).The association between cardiovascular autonomic dysfunction and microalbuminuria was estimated by multiple linear regressions.

Results: Patients with microalbuminuria had low levels of the autonomic function parameters i.e. mean CAFS, indicating impaired autonomic function. This association was consistent with increasing AER, and remained significant after multivariate adjustment for other clinical factors predictive of microalbuminuria. In additional analysis, we examined the autonomic function tests combined on the part of autonomic nervous system they predominantly represent. The results of these alternative combinations were comparable to those of the CAFS score.

Conclusion: Cardiovascular autonomic dysfunction was independently associated with microalbuminuria in patients with type 2 diabetes mellitus, and that this association is independent of other previously identified determinants of albuminuria in type 2 diabetes mellitus. Therefore cardiovascular autonomic function tests should be monitored to pay attention to major potential cardiovascular complications even in asymptomatic patients, but especially among those with microalbuminuria.

Key words: Microalbuminuria; Cardiovascular Autonomic Function Tests; Type 2 Diabetes Mellitus


 
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REFERENCES
1.Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. International Diabetes Federation. 3rd ed.Belgium: International Diabetes Federation;2006;15-103.


2. Faulkner MS, Hathaway DK, Milstead EJ, Burghen GA. Heart rate variability in adolescents and adultswith T1DM. Nursing Research 2001;50(2):95–104.
http://dx.doi.org/10.1097/00006199-200103000-00005
[
Pubmed]   

3. Gerstein HC, Mann JFE, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S, HOPE Study Investigators: Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421–426.
http://dx.doi.org/10.1001/jama.286.4.421


4. Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Soc Nephrol 2006;17:2106–2111.
http://dx.doi.org/10.1681/ASN.2005121288
[
Pubmed]   

5. Hanneke JBH, Beijers, Isabel F, Bert B, Dekker JM, Nijpels G, Heine RJ, COEN DA. Microalbuminuria and Cardiovascular Autonomic Dysfunction Are IndependentlyAssociated With Cardiovascular Mortality:Evidence for Distinct Pathways. Diabetes Care 2009;32:1698–1703.
[
Pubmed]    [PMC Free Fulltext]   

6. Smulders YM, Jager A, Gerritsen J, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD. Cardiovascular autonomic function is associated with (micro-)albuminuria in elderly Caucasian subjects with impaired glucose tolerance or type 2 diabetes: the Hoorn Study. Diabetes Care 2000;23:1369–1374.
http://dx.doi.org/10.2337/diacare.23.9.1369
[
Pubmed]   

7. Yokoyama H, Yokota Y, Tada J, Kanno S. Diabetic neuropathy is closely associated with arterial stiffening and thickness in type 2 diabetes. Diabet Med 2007;24:1329–1335.
http://dx.doi.org/10.1111/j.1464-5491.2007.02278.x
[
Pubmed]   

8. World health organization expert consultation: Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-163.
http://dx.doi.org/10.1016/S0140-6736(03)15268-3


9. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-2572.
http://dx.doi.org/10.1001/jama.289.19.2560
[
Pubmed]   

10. Rodicio JL, Campo C, Ruilope LM. Microalbuminuria in essential hypertension. Kidney Int 1998;54:1523–1555.
http://dx.doi.org/10.1046/j.1523-1755.1998.06813.x


11. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA2001;285(19):2486-2497.
http://dx.doi.org/10.1001/jama.285.19.2486


12. Vinik AI, Maser RE, Mitchell BD, Freeman R: Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553–1579.
http://dx.doi.org/10.2337/diacare.26.5.1553
[
Pubmed]   

13. Ewing DJ, Martyn CN, Young RJ, Clarke BF: The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985;8:491– 498.
http://dx.doi.org/10.2337/diacare.8.5.491
[
Pubmed]   

14. Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D, American Diabetes Association. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005;28:956–962.
http://dx.doi.org/10.2337/diacare.28.4.956
[
Pubmed]   

15. Imholz BP, Wieling W, van Montfrans GA, Wesseling KH: Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc Res 1998;38:605–616.
http://dx.doi.org/10.1016/S0008-6363(98)00067-4


16. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:1043–1065.
http://dx.doi.org/10.1161/01.CIR.93.5.1043


17. Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy.BMJ 1982;285:916–917.
http://dx.doi.org/10.1136/bmj.285.6346.916
[
Pubmed]    [PMC Free Fulltext]   

18. Spallone V, Gambardella S, Maiello MR, Barini A, Frontoni S, Menzinger G: Relationship between autonomic neuropathy, 24-hour blood pressure profile, and nephropathy in normotensive IDDM patients. Diabetes Care 1994;17:578–584.
http://dx.doi.org/10.2337/diacare.17.6.578
[
Pubmed]   

19. Neil HAW, Thompson AV, John S, McCarthy ST, Mann JI: Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population. Diabet Med 1989;6:20–24.
http://dx.doi.org/10.1111/j.1464-5491.1989.tb01133.x
[
Pubmed]   

20. Cohen JA, Jeffers BW, Faldut D, Marcoux M, Schrier RW: Risks for sensorimotor peripheral neuropathy and autonomic neuropathy in noninsulin-dependent diabetes mellitus. Muscle Nerve 1998;21:72–80.
http://dx.doi.org/10.1002/(SICI)1097-4598(199801)21:1<72::AID-MUS10>3.0.CO;2-2


21. Wirta OR, Pasternack AI, Mustonen JT, Laippala PJ, Reinikainen PM: Urinary albumin excretion rate is independently related to autonomic neuropathy in type 2 diabetes mellitus. J Intern Med 1999;245:329–335.
http://dx.doi.org/10.1046/j.1365-2796.1999.00499.x
[
Pubmed]   

22. Jermendy G, Ferenczi J, Hernandez E, Farkas K, Nadas J: Day–night blood pressure variation in normotensive and hypertensive NIDDM patients with asymptomatic autonomic neuropathy. Diabetes Res Clin Pract 1996;34:107–114.
http://dx.doi.org/10.1016/S0168-8227(96)01344-7


23. Ritz E, Stefanski M: Diabetic nephropathy in type II diabetes. Am J Kidney Dis 1996;27:167–194.
http://dx.doi.org/10.1016/S0272-6386(96)90538-7


24. Hilsted J: Pathophysiology in diabetic autonomic neuropathy: cardiovascular, hormonal, and metabolic studies. Diabetes 1982;31:730–737.
[
Pubmed]   

25. Strojek K, Grzeszczak W, Gorska J, Leschinger MI, Ritz E: Lowering of microalbuminuria in diabetic patients by a sympathicoplegic agent: novel approach to prevent diabetic nephropathy? J AmSoc Nephrol 2001;12:602–605.
[
Pubmed]   

26. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 1993;88:927–934.
http://dx.doi.org/10.1161/01.CIR.88.3.927
[
Pubmed]   

27. Gerritsen J, TenVoorde BJ, Dekker JM, Kingma R, Kostense PJ, Bouter LM, Heethaar RM. Measures of cardiovascular autonomic nervous function: agreement, reproducibility, and reference values in middle age and elderly subjects. Diabetologia 2003;46:330–338.
[
Pubmed]   

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How to Cite this Article
Pubmed Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. Natl J Physiol Pharm Pharmacol. 2012; 2(2): 84-92. doi:10.5455/njppp.2012.2.84-92


Web Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. http://www.njppp.com/?mno=22110 [Access: December 10, 2018]. doi:10.5455/njppp.2012.2.84-92


AMA (American Medical Association) Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. Natl J Physiol Pharm Pharmacol. 2012; 2(2): 84-92. doi:10.5455/njppp.2012.2.84-92



Vancouver/ICMJE Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. Natl J Physiol Pharm Pharmacol. (2012), [cited December 10, 2018]; 2(2): 84-92. doi:10.5455/njppp.2012.2.84-92



Harvard Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar (2012) Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. Natl J Physiol Pharm Pharmacol, 2 (2), 84-92. doi:10.5455/njppp.2012.2.84-92



Turabian Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. 2012. Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. National Journal of Physiology, Pharmacy and Pharmacology, 2 (2), 84-92. doi:10.5455/njppp.2012.2.84-92



Chicago Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. "Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus." National Journal of Physiology, Pharmacy and Pharmacology 2 (2012), 84-92. doi:10.5455/njppp.2012.2.84-92



MLA (The Modern Language Association) Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar. "Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus." National Journal of Physiology, Pharmacy and Pharmacology 2.2 (2012), 84-92. Print. doi:10.5455/njppp.2012.2.84-92



APA (American Psychological Association) Style

Deepak N Parchwani, Jatin V Dhanani, Amit A Upadhyah, Manojkumar H Sharma, Amit M Shah, Pankaj B Maheria, Kamlesh M Palandurkar (2012) Relationship between cardiovascular autonomic (dys)function and microalbuminuria in type 2 Diabetes Mellitus. National Journal of Physiology, Pharmacy and Pharmacology, 2 (2), 84-92. doi:10.5455/njppp.2012.2.84-92





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